Device and method for control of hemorrhage

ABSTRACT

A junctional and truncal tourniquet and a hip-girdling pelvic sling device for maintaining a desired amount of tension surrounding a person&#39;s hips and pelvis to securely support and stabilize a pelvis that has been fractured and for securing a pressure applying device to a person with a preferred amount of tension so that blood vessel-occluding pressure can be applied. Areas of mating types of fastener material such as mating hook-bearing fastener material and loop pile fastener material are arranged on the device to enable a strap to be secured at various effective lengths to provide a wide range of adjustability. The device may include inflatable bladders, and may be wrapped around a patient&#39;s torso to occlude blood vessels proximal to an injury on a limb. A bladder may be expandable in distinct tiers and may carry a separate and removable pressure-concentrating fitting. An auxiliary strap may be included and may be used to keep the junctional and truncal tourniquet in place on a patient&#39;s torso.

BACKGROUND OF THE INVENTION

The present invention relates to emergency treatment and control ofhemorrhage in places where compression is needed but a tourniquet is notdesired, and where control by compression is difficult.

Serious injuries, as in military conflict or automobile collisions, forexample, often result in hemorrhage. Two types of hemorrhage that arenot addressed well by currently available products arenon-tourniquetable compressible hemorrhage and noncompressiblehemorrhage.

Internal bleeding due to a fractured pelvis can easily result in death.Rapidly reducing a fracture of a pelvis decreases mortalitysubstantially, and devices are known for reducing a fracture andstabilizing the fractured pelvis in emergency situations, so that apatient can be transported to a hospital or other treatment facility.Stabilization of the pelvis within the first hour after a fractureoccurs is critical and may often determine whether the patient lives ordies.

Bleeding can often be stopped on a hemorrhaging wound if direct pressureis applied, but a tourniquet often cannot be used when the wound iseither not on an extremity or is too close to the torso for effectivetourniquet use. For a non-compressible hemorrhaging wound, directpressure is not possible or not effective, so one must occlude thevasculature proximal to the injury site. It is common that wounds in thejunctional or torso area occur in polytrauma patients, where thebleeding wound is not the only injury. In cases where pelvic fracture isalso present, the pelvis should be reduced to a controlled compressionlevel in order to prevent internal exsanguination.

Krieg, et al., U.S. Pat. Nos. 6,554,784 and 7,008,389 disclose deviceswhich can be used to encircle the hips of an injured person and providea proper amount of hoop tension to urge the parts of a person'sfractured pelvic ring toward a normal relationship and thus reduceinternal bleeding at the site or sites of fracture.

Ward, U.S. Patent Application Publication Document No. US 2010/0179586discloses a belt system with inflatable bags attached and adjustable inposition, for use in control of hemorrhage in regions of the body whereit is difficult to apply conventional compression, but differentoperators may adjust the belt to different levels of tightness. Ifstabilization of a pelvic fracture is desired at the same time asarterial hemorrhage control through the bladder, the reduction force tothe pelvis may be excessive or the force applied to achieve hemostasismay be inadequate.

SUMMARY OF THE INVENTION

The present invention, as defined by the claims which form a part of thedisclosure herein, provides an answer to the aforementioned need for away to provide pressure to occlude blood vessels or compress a wound,and one embodiment may incorporate a device for encircling a pelvis thathas been fractured, reducing the fracture, and stabilizing the pelvis byproviding a predefined amount of encircling tension.

A device that is one embodiment of the device disclosed herein willcontrol junctional hemorrhage (groin and axilla) in a combat environmentby applying pressure proximal to or directly over a major arterialbleed.

The present disclosure describes a combination of a binder such as abelt-like device which controls the circumferential compression force toa predefined level, and a harness or similar support system useful inother places on a person, combined with one, two or more point pressuredevices which when activated may either occlude vessels or compress awound. In one embodiment the device is secured using a spring controlledbuckle mechanism, which guides the user to a controlled baselinecircumferential force. This controlled baseline force ensures thatinflation of the point pressure devices will achieve a consistent anddesired tissue compression depth for occlusion of the artery. In oneembodiment the belt incorporates a flat non-repositionable inflatablebacking bladder to provide an additional and customizable force level.

As a first aspect of a device as disclosed herein, a wide belt-like mainbody of a device for stabilizing a fractured pelvis has a pair ofopposite end portions, one of which carries a buckle, and the other ofwhich has an inner end of a strap member attached thereto. The strapmember is arranged to extend through the buckle and to be doubled backto extend toward the end of the main body to which its inner end isattached. Fastener material is present in locations providing a widerange of adjustment of the effective lengths to provide a wide range ofadjustability.

In one embodiment of the device disclosed herein, fastening materialsuch as Velcro™ hook-bearing fastener material is provided on an outerend portion of the strap, and material such as Velcro™ loop-bearingfastener material is provided along an intermediate portion of thestrap.

In one embodiment of the device, a surface of the main body of thedevice, at the end from which the strap extends, is securely andmatingly receptive to hook-bearing fastener material such as Velcro™hook-bearing fastener material located on the outer end portion of thestrap.

In one embodiment of the device disclosed herein, material of much ofthe outer face of the end portion of the main body of the device isreceptive to fastener material of the Velcro™ hook-bearing type, and anarea of hook-bearing fastener material of the Velcro™ type is alsolocated on the end portion, where it can engage and grip theloop-bearing fastener material on the intermediate portion of the strapwhen the strap is doubled back alongside itself and pulled through thebuckle far enough for the device to fit around the pelvic area of arelatively slender injured person with the necessary amount of tension.

In one embodiment of the device disclosed herein one or more inflatablebladders may be included in the main body, to provide additionalsomewhat localized pressure, either as a pelvis-stabilizing device or toassist in closing and supporting tissue around an open wound.

One embodiment of the device described herein includes point pressuredevices that can be held by the belt-like portion of the device, eitherdirectly over a wound or proximal to the wound to occlude the proximalvessels and stop or control bleeding.

One embodiment of the device is compact and light in weight so as tominimize effort needed to carry it in readiness for use in a militaryenvironment.

An inflatable bladder, in one embodiment, may in use provide pressure atseveral points along the length of a blood vessel.

The foregoing and other features of the invention will be more readilyunderstood upon consideration of the following detailed description ofthe invention taken in conjunction with the accompanying drawings.

BRIEF DESCRIPTION OF THE SEVERAL DRAWINGS

FIG. 1 is an isometric view of a pelvis-stabilizing device that is anexemplary embodiment of an aspect of the present invention.

FIG. 2 is a front elevational partially cutaway view of thepelvis-stabilizing device shown in FIG. 1, showing the device extendingaround the pelvic area of a person and showing a portion of the skeletonof the person to illustrate the proper location of the device duringuse.

FIG. 3 is a top plan view of the pelvis-stabilizing device shown inFIGS. 1 and 2, under tension and with the strap shown secured so as tomaintain tension to keep the buckle engaged while the device is fastenedaround a person of a minimum size for use of the device.

FIG. 4 is an isometric front view of end portions of the main body ofthe pelvis-stabilizing device shown in FIGS. 1-3, illustrating thedevice secured and under tension at a small circumference, as if to fita slender person.

FIG. 5 is an isometric view of a buckle useful as a part of thepelvis-stabilizing device shown in FIGS. 1-4.

FIG. 6 is a sectional view of the buckle shown in FIG. 5, taken alongline 6-6 of FIG. 5, with the buckle in a relaxed condition.

FIG. 7 is a view similar to FIG. 6, but showing the condition of thebuckle when subjected to a predetermined tension to cause the buckle toengage a strap that is a part of the pelvis-stabilizing device shown inFIGS. 1-4.

FIG. 8 is a view similar to FIG. 4 showing the pelvis-stabilizing andsupporting device under tension so that the buckle engages the strap, ata larger circumference than that shown in FIG. 4, as if properly inplace on a larger person.

FIG. 9 is a view similar to FIG. 8, showing the pelvis-stabilizing andsupporting device with the strap under tension and engaged by the beltat yet a larger circumference than that shown in FIG. 8, as if properlysecured in place on a yet larger person.

FIG. 10 is a view similar to FIG. 9, showing the pelvis-stabilizing andsupporting device with the strap under tension and engaged by the buckleas if properly secured in place around a person of yet largercircumference, near the maximum for the size of the device.

FIG. 11 is an isometric view of an alternative embodiment of thepelvis-stabilizing device shown in FIGS. 1-10, which may also be used asa cervical collar for the protection of a person's neck.

FIG. 11A is a sectional view taken along line A-A in FIG. 11.

FIG. 12 is an isometric view of the main body portion of apelvis-stabilizing device which is another alternative embodiment of thedevice shown in FIGS. 1-10.

FIG. 13 is an isometric view of the main body portion of apelvis-stabilizing device which is yet a further alternative embodimentof the device shown in FIGS. 1-10.

FIG. 14 is a perspective view showing the pelvis-stabilizing deviceshown in FIGS. 11 and 11A in use as a cervical collar to support aperson's neck.

FIG. 15 is a perspective view of a pelvis-stabilizing device which isyet another alternative embodiment of the device shown in FIGS. 1-10,which may also be used as a cervical collar to support a person's neck.

FIG. 16 is a perspective view of the pelvis-stabilizing device shown inFIG. 15 in use as a cervical collar to support a person's neck.

FIG. 17 is a view of an end portion of the main body of apelvis-stabilizing and neck-supporting device similar to that shown inFIG. 15 and incorporating a chin rest, shown in a non-deployed positionwith respect to the body portion of the pelvis-stabilizing and necksupporting device.

FIG. 18 is a view similar to FIG. 17, showing the chin rest in adeployed position.

FIG. 19 is a perspective view of the pelvis-stabilizing and necksupporting device shown in FIGS. 17 and 18 in use as a cervical collarto support a person's neck.

FIG. 20 is an isometric view of a junctional and truncal pointtourniquet and pelvis-stabilizing device that is an exemplary embodimentof one aspect of the present invention.

FIG. 21 is an isometric view of another junctional and truncal pointtourniquet and pelvis-stabilizing device that is an exemplary embodimentof one aspect of the present invention, in which a main body is of aminimal width.

FIG. 22 is an isometric view of the main body portion of a device suchas that shown in FIG. 21, together with an inflatable bladder attachedto the main body portion of the device.

FIG. 23 is a front elevational view of the junctional and truncal pointtourniquet and pelvis-stabilizing device shown in FIG. 21, together withan inflatable bladder attached to the main body portion of the device,in use on a pelvic area of a person.

FIG. 24 is a side elevational view showing how a junctional and truncalpoint tourniquet and pelvis-stabilizing device shown in FIG. 20 might beused on a person in a selected one of three different possible positionsto stabilize a fractured pelvis.

FIG. 25 is a front view of the junctional and truncal point tourniquetand pelvis-stabilizing device shown in FIG. 20 in use, with a pair ofinflatable point pressure exerting members located so as to occlude aperson's femoral arteries.

FIG. 26 is a front view of the junctional and truncal and pointtourniquet and pelvis-stabilizing device shown in FIG. 21 in use, with apair of inflatable point pressure exerting members located so as toocclude a person's femoral arteries.

FIG. 27 is a front elevational view showing the device shown in FIG. 21applied around a patient's upper torso, so as to occlude an axillaryartery.

FIG. 28 is an isometric view of the device shown in FIGS. 21, 22, and26, rolled into a compact configuration for packaging.

FIG. 29 is an isometric view of an inflatable pressure applicationdevice such as the ones shown in FIGS. 20, 21, 24, 25, and 26 in adeflated condition.

FIG. 30 is an isometric view of the device shown in FIG. 29 in aninflated condition and inverted.

FIG. 31 is a sectional view taken along line 31-31 in FIG. 29.

FIG. 32 is a sectional view taken along line 31-31 of FIG. 29, butshowing the flexible bladder in an inflated condition.

FIG. 33 is an isometric view of another junctional and truncal pointtourniquet and pelvis-stabilizing device that is an exemplary embodimentof an aspect of the present invention.

FIG. 34 is an isometric view of an inner face of the main body portionof the device shown in FIG. 33, together with a point pressure device inplace thereon, at an enlarged scale.

FIG. 35 is a view of the outer side of a portion of the device shown inFIG. 33, at an enlarged scale, showing an auxiliary strap extended andavailable for use.

FIG. 36 is a view similar to that of FIG. 25, showing the use of thejunctional and truncal point tourniquet and pelvis-stabilizing deviceshown in FIGS. 33-35.

FIG. 37 is a view of the back of the patient shown in FIG. 36, with thedevice shown in FIGS. 33-35 in use.

FIG. 38 is a front elevational view of the device shown in FIGS. 33-35in use as applied to a patient's upper torso and used to occlude anaxillary artery.

FIG. 39 is a rear elevational view of a patient's torso with the devicein use as shown in FIG. 38.

FIG. 40 is an isometric view of yet another junctional and truncal pointtourniquet and pelvis-stabilizing device that is another embodiment ofan aspect of the present invention.

FIG. 41 is an isometric view of an inner face of the main body portionof the device shown in FIG. 40, at an enlarged scale.

FIG. 42 is an isometric view of an outer face of a mid-length portion ofthe main body part of the device shown in FIG. 40, showing an auxiliarystrap extended from within a pocket in the main body portion of thedevice.

FIG. 43 is a front elevational view of a patient's torso with the deviceshown in FIGS. 40-42 in place and retaining an inflatable point pressuredevice so as to occlude an axillary artery.

FIG. 44 is a rear elevational view of the patient's torso with thedevice shown in FIGS. 40-42 in place as shown in FIG. 43.

FIG. 45 is a somewhat schematic view showing an inflatable pointpressure device such as the one shown in FIGS. 29-32 in section view andin contact with a patient's body, showing the locations where pressureis applied to the patient's body with the inflatable point pressuredevice in an uninflated condition.

FIG. 46 is a view similar to FIG. 45 but showing the inflatable pointpressure device partially inflated, with one of the ridges surroundingthe central pressure member in contact with the patient.

FIG. 47 is a view similar to FIGS. 45 and 46, but showing the inflatablepoint pressure device fully inflated so that only the central pressuremember is in direct contact against the patient's body.

FIG. 48 is a view similar to FIG. 46, showing a pressure concentratingmember in place on the central pressure member.

FIG. 49 is a perspective view from above and at one side of thepressure-concentrating member shown together with an inflatable pointpressure device in FIG. 48.

FIG. 50 is a perspective view from the bottom of the pressureconcentrating member shown in FIG. 49.

FIG. 51 is a perspective view from above and at one side of thepressure-concentrating member shown in FIGS. 49 and 50 in place on aninflatable point pressure device.

FIG. 52 is an isometric view of the pelvis supporting and stabilizingdevice and truncal and junctional tourniquet shown in FIGS. 33-39 in acompact package.

DETAILED DESCRIPTION OF EMBODIMENTS

Referring first to FIGS. 1-4 of the drawings which form a part of thedisclosure herein, a pelvis supporting and stabilizing device 12 forstabilizing a fractured pelvis, hereinafter often called a pelvic sling,is shown in FIG. 1 ready for application to a person to providestabilization and support for a fractured pelvic ring by encircling thehip region of a person. A main body portion 14 is of strong flexiblematerial and has the general shape of a wide belt. A buckle 16 isattached to a first end portion 18 of the main body 14 by a small loopof a strap 20 of strong fabric such as woven webbing, permanentlyattached to the first end portion 18, as by being sewn securely to it.As used herein the term “permanently attached” means that removal andreattachment are not easily accomplished by a user and cannot beaccomplished readily without use of equipment such as that needed forinitial manufacture. The fabric of the strap 20 also defines a largeloop 22, attached to the first end portion 18 so that it can be used asa handle by a person applying the pelvic sling 12 to an injured person,as will be explained more fully presently.

A central portion of the main body 14 may be covered on an exterior faceby a sheet 24 of low friction flexible plastic material which will beexposed on the posterior side of a person on whom the pelvic sling 12 isin use, facilitating movement of such person on a backboard or othersupport.

At a second end portion 26, opposite the first end portion 18, an innerend 28 of an elongate flexible strap 30 is permanently attached to themain body 14, as by being sewn, riveted, or thermally or sonicallywelded securely to the second end portion 26 of the main body 14. Thestrap 30 extends longitudinally away from the second end portion 26,generally aligned with the longitudinal axis 32 of the main body 14. Anouter end portion 34 of the strap 30 may include a loop 36 of strongfabric such as Nylon webbing attached to an intermediate portion 38 ofthe strap 30, which may be of heavier and consequently slightly stiffer,yet still flexible, webbing. The loop 36 may be securely sewn orotherwise permanently attached to the intermediate portion 38 of thestrap 30. The loop 36 is thus available for use as a handle to pull thestrap 30 away from the buckle 16, as will be explained more fullypresently.

Pairs of holes 40 may be defined in the intermediate portion 38 of thestrap 30. The holes 40 of each pair are aligned with each othertransversely across the width 42 of the strap 30 and loop 36, which maybe about two inches, for example. Adjacent pairs of holes 40 may beevenly spaced apart longitudinally of the strap 30 at a pitch 44 of, forexample, 0.625 inch, so as to permit the effective circumference of thepelvic sling 12 to be adjusted in increments small enough to provide adesirable amount of tension in the pelvic sling 12 encircling a person'ships to stabilize a fractured pelvis.

The main body portion 14 may be of laminated fabric, and may include acentral layer of padding material (not shown), between an inner layer 46of a comfortably soft yet strong fabric such as a Nylon tricot material,on the side of the main body 14 intended to be placed against a person,and an exterior layer 48 of a strong fabric such as a tricot material ofNylon or another synthetic material brushed to produce a nap of fiberloops that can act as a fastener material of a first kind, such as aloop-bearing fastener material capable of being engaged matingly by afastener material of a second kind, such as a hook-bearing flexiblefastener material such as that well known under the trademark Velcro. Asused herein, the terms “loop-bearing fastener material” and“hook-bearing fastener material” will refer to fastener material thatfunctions similarly to the Velcro™ combination of loop-pile fabric and“thistle-cloth” to stick removably together. Thus, for example, suchloop-bearing fastener material is a first kind of flexible fastenermaterial and such hook-bearing material is a second kind of flexiblefastener material that can matingly engage the first kind of flexiblefastener material.

A binding 49 may be provided around the exterior margin of the main body14, and an adhesive may also be used to keep the inner and exteriorlayers 46 and 48 together with the central layer.

An exterior side 50 of the intermediate portion 38 of the strap 30 maybe covered by a layer of a flexible loop-bearing fastener material 52,securely attached to the strap 30, as by being sewn to the webbing. Suchloop-bearing fastener material 52 ideally may be present along theentire exterior side or face 50 of the strap 30, the side that isexposed in the same general direction as the exposed face of theexterior layer 48, from a point abutting the outer end portion 34 to thesecond end portion 26 of the main body 14, and may be present on theinner end 28 of the strap 30.

A piece of hook-bearing fastener material 54 may be securely attached tothe exterior side 50 of the outer end portion 34 of the strap 30, as bybeing sewn to the webbing material forming the loop 36. Thus the areahook-bearing fastener material 54 may abut against the loop-bearingfastener material 52 on the exterior side 50 of the intermediate portion38 of the strap 30.

At least one area 58 of hook-bearing fastener material is located on thesecond end portion of the main body 14. Advantageously, each area 58 maybe a narrow, elongate piece of hook-bearing fastener material with awidth 60 less than the width 42 of the strap 30, and a length 62,extending generally parallel with the longitudinal axis 32 of the mainbody portion 14. Such elongate areas 58 may be separated laterally fromone another by a distance 64. For example, where the width 42 of thestrap 30 is two inches, the width 60 of each area 58 may be about 0.75inch, and the distance 64 between areas 58 may be about one inch. Thelength 62 may be as great as can be accommodated in the second endportion 26 and thus may be, for example, in the range of about 5 inchesto about 7.3 inches, depending on the size of the pelvic sling 12. Aswill be understood in light of subsequent explanation, the foregoingdimensions are not critical, but the relationships of the width 60 andthe distance 64 with the width 42 of the strap 30 can providesignificant functional advantages.

As may be seen in FIG. 2, when the pelvic sling 12 is properly in placeon an injured person, it encircles the person's hips and buttocks at thelevel of the greater trochanters 66 and the symphysis pubis, with themain body portion 14 extending around the posterior of the person. Thefirst and second ends 18 and 26 extend forward around the person's bodyand toward each other at the anterior side of the abdomen, with thestrap 30 extending through the buckle 16 and doubled back toward thesecond end portion 26 of the main body portion 14, along the exterior ofthe pelvic sling 12. Although the pelvic sling 12 is shown consistentlyin one orientation herein, it is to be understood that it may besymmetrical in shape, about the central longitudinal axis 32, and thuscan just as well be placed on a person with the buckle 16 and strap 30oriented oppositely with respect to the person.

When the pelvic sling 12 is properly in place there is a prescribedamount of tension maintained in the main body portion 14 as it encirclesthe injured person, so that a fracture 70 in the pelvic ring is reduced.That is, the portions of the fractured bone are held together andstabilized by the tension in the pelvic sling 12. This tension ismaintained by engagement of the buckle 16 with the strap 30. The desiredamount of tension exerted on the buckle 16 by the strap 30 causes aportion of the buckle 16 to move, exposing pins 72 which extend throughthe ones of a pair of holes 40. As shown in FIGS. 2, 3, and 4, theouter, or pulled end, part 80 of the intermediate portion 38 of thestrap 30 extends along the second end portion 26 of the main body 14,parallel with the outer surface of the exterior layer 48 when the device12 is adjusted to a nearly minimum circumference. The loop-bearingfastener material 52 on the exterior side 50 of the strap 30 is alignedwith and in mating contact with one of the areas 58 of hook-bearingfastener material, as shown in FIG. 2, so that the hook-bearing material58 is matingly engaged with the loop-bearing fastener material 52 on thestrap 30. Mating engagement of the fastener materials 58 and 52 issufficient to maintain the tension in a portion 74 of the strap 30between the inner end 28 and the buckle 16 to keep the pins 72 engagedin the holes 40 and thus keep the strap 30 engaged with the buckle 16.

The buckle 16 may be substantially similar to the buckle described inU.S. Pat. No. 7,008,389. Thus, as shown in FIGS. 5, 6, and 7, the buckle16 includes two main parts, a rigid frame 82 and a sliding block 84. Oneside of the frame 82 is secured to the first end portion 18 of the mainbody portion 14 by a small loop of the fabric of the strap 20. Thesliding block 84 is moveable relative to the buckle frame 82 in thedirections indicated by the arrow 86. The strap 30 may extend throughthe opening defined by the frame 82, sliding along the contact surfaceof the curved face 87 of the sliding block 84 when the strap 30 ispulled to tighten the pelvic sling 12 about a person's pelvis. A pair ofholes 88 are defined in the sliding block 84, and the pins 72 extendinto the holes 88, with their ends preferably flush with the face 87when the buckle 16 is not in tension. When a pair of holes 40 in thestrap 30 then move into alignment with the holes 88 in the sliding block84 the sliding block 84 is moved leftward toward the position shown inFIG. 6, so that the pins 72 protrude from the holes 88 and can extendthrough the holes 40, thus engaging the strap 30 and preventing it frommoving relative to the buckle 16, apart from any differences in sizebetween the pins 72 and the holes 40.

FIGS. 6 and 7 show a spring 90 positioned around one of the pins 72. Anidentical spring 90 may be used on the other pin 72. The springs 90 arecompressed significantly when the sliding block 84 is in its fullyextended position, as shown in FIG. 5, so that substantial force must beapplied to the buckle 16 by tension in the straps 20 and 30 before thesliding block 84 begins to move relative to the buckle frame 82.Internal springs 90 are compressed further as the sliding block 84 movesleftward toward the position shown in FIG. 6 when there is sufficienttension in the strap 30. Flanges 92 on the buckle frame 82 are engagedby lips 94 on the sliding block 84 when the sliding block 84 is in thefully extended position as shown in FIGS. 5 and 6, thus withstanding thecompressive force in the springs 90.

As the sliding block 84 moves leftward toward the position shown in FIG.2 from the position shown in FIG. 6, the lips 94 ride up and over thetops of the ramps 96 beneath the flanges 92, so that movement of thesliding block 84 may create an audible click as the sliding block 84moves along the pins 72 and the pins extend into the holes 40,indicating to the user that the buckle 16 is engaged with the strap 30.Thereafter the inwardly directed elastic force in the sides of thesliding block 84 presses the lips 94 against the ramps 96 and helps tokeep the pins 72 engaged in the holes 40, so that a slightly loweramount of tension in the portion 80 of the strap between the pins 72 andthe loop 36 is sufficient to keep the sliding block in the leftwardlydepressed position, once the pins 72 have become engaged in the holes 40as shown in FIGS. 2 and 4.

As the strap 30, when the outer end 34 is pulled away from the buckle16, passes over the curved face 87 of the sliding block, when thepredetermined tension is applied to the buckle 16 by the strap 30, thesliding block 84 moves, further compressing the springs 90 and allowingthe pins 72 to extend from the holes 88 and proceed through the holes40, preventing further movement of the strap 30 around the sliding block84. The holes 40 in the strap 30 may have a slightly larger diameterthan the largest transverse dimension of the pins 72, so that engagementof the pins 72 in the holes 40 occurs easily and smoothly at the desiredtension in the strap 30. Thus, as described in previously mentioned U.S.Pat. No. 7,008,389, when the proper amount of tension has been reachedin the portion of the pelvic sling 12 wrapped around an injured person,the buckle 16 will engage the strap 30, and so long as tension in thepulled portion 80 of the strap 30 extending beyond the buckle 16 is notgreatly reduced, the pins 72 will remain engaged in the holes 40. Itwill be understood that the buckle 16 could be constructed to includeonly one pin 72 or more than two pins 72 and that the strap 30 could beprovided with compatibly located holes 40.

Once the pins 72 have engaged the holes 40, tension should besubstantially maintained in the outer or pulled portion 80 of the strap30, and the pulled portion 80 should be moved toward the person on whomthe pelvic sling is being used and should be pressed against the outerend portion 26 of the main body 14 to engage the two mating kinds offastener material with one another to retain the strap 30 at the desiredlocation.

It would be possible to use other buckles (not shown), instead of thebuckle 16, so long as such buckles can sense a predetermined amount oftension and engage the strap 30 in response.

As a result of the locations and sizes of the areas of hook-bearingfastener material 54 and 58 and the loop-bearing fastener material 52 onthe exterior face 50 of the strap 30, the portion 80 of the strap 30extending outside the buckle 16 and being pulled by a person applyingthe pelvic sling 12 to an injured person is able to be securely held bythe combination of hook-bearing fastener material and loop-bearingfastener material at any effective circumference of the pelvisstabilizing pelvic sling device 12 at which the pins 72 of the buckle 16may be engaged in a pair of holes 40 along the strap 30. Thus, as shownin FIGS. 2, 3, and 4, with the effective circumference of the pelvicsling 12 at or near a minimum, the area of hook-bearing fastenermaterial 58 aligned centrally along the second end portion 26 of themain body is engaged with a confronting portion of the loop-bearingfastener material 52 on the exterior side 50 of the strap 30. Anavailable area of hook-and-loop fastener engagement is thus equal to thearea of the hook-bearing fastener material 58 of one of the 3 stripsshown in FIG. 1, and the mated fastener materials can hold the outer, orpulled end, portion 80 of the strap 30 securely enough to maintainenough tension in that portion 80 of the strap 30 so that the pins 72 ofthe buckle remain exposed beyond the sliding block 84 and engaged in theholes 40 of the strap 30.

In FIG. 8, the pelvis-stabilizing pelvic sling 12 is shown in tension aswhen in place on a person having a larger girth, and the loop-bearingfastener material 52 of the intermediate portion 38 of the strap 30 isnot aligned with the area of hook-bearing fastener material 58. Instead,as shown in FIG. 8 the hook-bearing fastener material 54 mounted on theloop 36 of the outer end portion 34 is engaged with the loop-bearingfabric of the exterior layer 48 of the outer end portion 26 of the mainbody 14 on each side of the centrally located area of hook-bearingfastener material 58. As previously mentioned the fabric of the exteriorlayer 48 functions as loop-bearing fastener material. Accordingly,engagement of the area of hook-bearing fastener material 54 with thefabric 48 maintains sufficient tension in the outer, or pulled, portion80 of the strap 30 to keep the pins 72 of the buckle 16 engaged in apair of holes 40 in the strap 30, to maintain the proper amount oftension in the pelvic sling 12 to support and stabilize a person'sfractured pelvis. It will be apparent that the loop 36 could be locatedslightly differently with the same position of the strap 30 with respectto the buckle, as shown in broken line. Thus the hook-bearing fastenermaterial 54 could engage the fabric of the exterior layer 48 largelybetween two of the areas 58 of hook-bearing fastener material,overlapping somewhat on each of the areas 58, rather than by straddlinga single area 58.

As shown in FIG. 9, with the pelvis-stabilizing pelvic sling 12 in placeunder proper tension on a somewhat larger person than in FIG. 8, thehook-bearing fastener material 54 on the loop 36 at the outer end 34 ofthe strap 30 may be engaged with loop-bearing fastener material 52 atthe inner end 28 of the strap 30 where it is attached to the second endportion 26 of the main body 14 and may also be engaged with the fiberloops of the fabric of the exterior layer 48 of the outer end portion26, to the extent that the area of hook-bearing fastener material 54extends beyond the inner end portion 28 of the strap 30.

As may be seen in FIG. 10, with the pelvis-stabilizing pelvic sling 12under the proper amount of tension to stabilize and support a fracturedpelvis in an even larger person, the hook-bearing fastener material 54on the loop 36 at the outer end of the strap 30 can mate securely withthe loop-bearing fastener material 52 on the portion 74 of the strap 30between the second end portion 26 of the main body 14 and the buckle 16.The mated hook-bearing fastener material 54 and loop-bearing fastenermaterial 52 securely maintain sufficient tension in the strap 30 as itis engaged with the buckle 16 to keep the pins 72 engaged in a pair ofholes 40 in the strap 30.

Thus by referring to FIGS. 4, 8, 9, and 10, it may be seen that,regardless of the circumference of the person on whom the device 12 isbeing used, within a relatively wide range of different circumferences,application of the device 12 is very straightforward. As a result of theavailability and locations of the areas of flexible fastener material oftwo mating kinds, located on the second end portion 26 of the main body14, on the strap 30, and on the loop 36, the outer, or pulled end,portion 80 of the strap 30 that extends beyond the buckle 16 can befastened securely enough to maintain tension in the strap 30 to actagainst the sliding block 84 and thus maintain engagement of the buckle16 with the pins 72 in any of the pairs of holes 40 along the part ofthe strap 30 extending beyond the second end portion 26 of the main body14.

As the inner end portion 28 of the strap 30 is permanently attached tothe second end portion 26 of the main body 14, adjustment of the pelvicsling 12 to provide the required amount of compression of the pelvis ofan injured person is accomplished by pulling the strap 30 through thebuckle 16, without first having to assemble any parts of the device. Thepelvic sling 12 is placed around the hips of an injured person suspectedof having a broken pelvis by sliding the main body portion 14 beneaththe hips of the injured person. With the person lying in a supineposition, the exterior side of the main body 14, the side shown in FIG.1, should be downward. This permits the low friction plastic sheet 24 toslide easily along a surface of a backboard or other surface on whichthe person is resting, and exposes the necessary portions of the pelvicsling 12 so that it can be fastened.

Proper application of the pelvic sling 12 to an injured person thus canbe accomplished simply and rapidly. First the sling should be placed atthe level of the greater trochanters 66 and symphysis pubis, and theloop 36 and strap 30 must be passed through the opening in the frame 82of the buckle 16 and around the curved face 87 of the sliding block 84.The pelvic sling can be tightened around a person by pulling the strap30 and the buckle 16 in opposite directions, using the large loop 22 asa handle to pull toward the patient's left, as shown by the arrow 76,and, by using the large loop 36 as a handle, pulling the outer end 34 ofthe strap 30 in the opposite direction when the strap 30 extends throughthe buckle 16 and is doubled back toward the injured person's rightside, as indicated by the arrow 78 in FIG. 2. The strap 30 is thuspulled through the buckle 16 until sufficient tension is achieved tomove the sliding block 84 and allow the pins 72 to become engaged in apair of holes 40 in the strap 30. While maintaining tension in the outerportion 80 of the strap 30 against the buckle 16, the flexible fastenermaterials can be engaged in one of the several alignments as describedabove to retain the tension in the strap 30 relative to the buckle 16and thus to keep the pins 72 engaged in the holes 40 of the strap 30 atany effective circumference of the pelvic sling 12 at which the pins 72are able to become engaged in a pair of holes 40.

Thus, engagement of the loop-bearing fastener material 52 of the strap30 with the hook-bearing material in the areas 58 on the second endportion gives a first range of smallest available effectivecircumferences of the pelvic sling 12. Engagement of the fabric of theouter layer 48 of the second end portion of the main body 14 gives asecond range of available, somewhat larger effective circumferences ofthe pelvic sling 12. Finally, engagement of the area 54 of hook-bearingfastener material of the outer end 34 of the strap with the loop-bearingfastener material 52 on the intermediate portion 38 of the strap 30gives a third range of available effective circumferences, and theadjacent parts of the ranges overlap each other.

The pelvic sling 12 is made from a minimal number of components, andpreferably of materials which are, except for the springs 90,radiolucent, and is ready for application as manufactured.

The pelvic sling 12 may be provided in various sizes. A normal sizepelvic sling 12 may have a length 98 of its main body of for example, 24inches, and larger and smaller sizes may be provided for use with veryslender or very large persons. For a normal size pelvic sling 12 thelength of the strap 30 combined with the extent of the loop 36 may besimilar to or slightly shorter than the main body length 98.

While the description above has described the use of hook-bearingfastener material and loop-bearing fastener material, othertwo-component flexible fastener systems could also be used by similarplacement of areas of the two matable fastener kinds on the strap 30 anda second end portion of a main body 14.

Referring next to FIGS. 11 and 11A, a pelvic sling 112 may also be usedas a cervical support, hereinafter simply called a cervical collar, thatcan be wrapped around a patient's neck, as will be explained presently.The pelvic sling 112 is in many ways similar to the pelvic sling 12, andso like reference numbers will be used with like components of thepelvic sling 112. The pelvic sling 112 includes an inflatable bladder114 in a central portion of the main body 14, where it may be locatedbetween two fabric layers 48 and 46. A fill tube 120 communicating withthe bladder 114 may be provided on the outer side of the pelvic sling112 at the first end portion 18 of the main body portion 14. A suitablefill fitting 122 may be provided on the fill tube 120 to permittemporary attachment of a squeeze bulb (not shown) or connection toanother source of air to inflate the bladder 114. The fill fitting 122may include a check-valve or other closure to maintain inflation of thebladder as required.

A piece of loop-bearing fastener material 123 may be provided on thesecond end portion 26 of the main body 14 as shown in FIG. 11, tosupplement the loop-bearing nature of the fabric layer 48 if desired, toprovide for secure engagement with the hook-bearing material 54 on theloop 36 at the outer end portion 34 of the strap 30.

A pair of elongate stays 124 and 126 are attached to the main bodyportion 14, as by strips 128 and 130 of strong fabric such as nylonwebbing material sewn to the outer layer 48 of fabric of the main bodyportion 14. The strips 128 and 130 of fabric might also be attached byother means such as thermal welding or adhesives, if more practical. Thestays 124 and 126 are spaced apart from each other along the length ofthe main body 14 and may reside near or even overlapping the respectiveopposite ends of the bladder 114, as may be seen in FIG. 11A. The stays124 and 126 may be narrow and elongate, and are held where they extendtransversely across the length of the main body 14, parallel with eachother, where they can provide support along the opposite sides of apatient's neck when the pelvic sling 112 is utilized as a cervicalcollar, as will be explained in greater detail presently.

Each of the fabric strips 128 and 130 may thus have a length equal tothe width of the main body portion 14 of the pelvic sling 112 and awidth, parallel with the length of the main body 14 of, for example,about two inches. Each stay 124 and 126 may each have a length enoughless than the width of the main body portion 14 to permit the oppositeends of the pieces of fabric 128 and 130 to be fastened securely to themain body 14 to capture the stays 124 and 126.

Each stay 124 or 126 may have a width of, for example, about 0.5 inch(1.25 mm), although the specific dimensions are not critical. Each ofthe stays 124, 126 may be made of a suitable metal with sufficientthickness to provide firm support for the main body 14. For example thestays 124, 126 may be of sheet steel or sheet aluminum, or a suitablecomposite material such as a fiber-reinforced resin of ample strength,with some amount of flexibility and resiliency.

It should be understood also that there might be only one, or more thantwo stays 124 and 126. Also, the stays might extend diagonally and mightnot be parallel with one another, in different embodiments of the pelvicsling, and might be wider and less elongate, or in the nature of smallplates of metal. In one version such stays or plates might be malleableenough to be bent to a desired configuration to help support a patient'sneck or pelvis.

An area 132 of flexible fastener material of the second kind, such ashook-bearing flexible fastener material, may be provided on the loop 36at the outer end of the strap member 30, facing in the same direction asthe inner side of the strap member 30, and thus opposite thehook-bearing material 54 on the outer end portion of the strap member30, to be used to fasten the outer end 34 of the strap member 30 to theintermediate portion 38 of the strap member 30. The area 132 of fastenermaterial may, as shown in broken line in FIG. 11, be an extension of thearea of 54 of hook-bearing flexible fastener material with one partthereof located as described with respect to the separate piece 132 soas to be exposed on the inner side of the strap member 30 at its outerend 34.

A flexible tension-bearing member of another sort, such as a flexiblecord, or cable, might also be attached to the second end portion 26 andused with a suitable fastener of a different sort, such as a spool orhook, (not shown) in place of the buckle 16 on the first end portion 18of the main body portion 14, to hold the main body around a patient'sfractured pelvis. Another sort of fastener (not shown) might then beused together with the flexible tension-bearing member to secure theelongate main body portion 14 wrapped around the neck of a patient P.

A pelvic sling 140 that can also be used as a cervical collar is shownin FIG. 12, but with only a short portion of the strap member 30. Thepelvic sling 140 is similar in most respects to the pelvic sling 112,and so will be described in detail only with respect to the significantdifferences. The principal difference in the pelvic sling 140 is that itincludes three separate bladders, each somewhat smaller than the bladder114 as illustrated in FIGS. 11 and 11A. A central bladder 142 is thelargest of the three and is located in substantially the same position,centrally within the main body portion 14, as the bladder 114 is in thepreviously described pelvic sling 112. Two more, smaller, bladders 144and 146 are located respectively in the first end portion 18 and thesecond end portion 26. The bladders 142, 144, and 146 may all beinstalled in the same general manner as is the bladder 114 shown inFIGS. 11 and 11A, and respective fill tubes and fill fittings (notshown), may be utilized to inflate each of the bladders 142, 144, and146, or the bladders may be interconnected with each other and inflatedthrough a single fill tube. The stays 124 and 126 and their associatedretaining fabric pieces 128 and 130 are, as shown in FIG. 12, locatedsimilarly to their locations as in the pelvic sling 112 shown in FIGS.11 and 11A and are between the central bladder 142 and the respectiveone of the end bladders 144 and 146.

A pelvic sling 150 is yet another embodiment of the pelvic sling, asshown in FIG. 13. The pelvic sling 150 is generally similar to thepelvic sling 140 shown in FIG. 12, except that it lacks the stays 124and 126 and their associated fabric strips 128 and 130, and, as aresult, there is room for the central bladder 152 and respective endbladders 154 and 156 to be somewhat larger and extend toward each otherslightly more closely than the similar locations of the bladders 142,144, and 146 of the sling 140. The bladders 142, 144, and 146 may beinflated when the pelvic sling 112 or 140 is used, taking care not toprovide too much tension in the pelvic sling.

Referring next to FIG. 14, the pelvic sling 112 is shown as used as acervical collar on a patient P. For use of the pelvic sling 112 as acervical collar, the main body portion 14 is wrapped around the neck ofthe patient P. The device 112 is placed around the neck of the patient Pwith the buckle 116 extending beyond the first end 18 of the main bodyportion and toward the posterior of the patient on the patient's righthand side. The strap member 30 is extended around the main body portionand overlapped onto its own intermediate portion 38, and the outer end34 of the strap member 30 is fastened to the intermediate portion 38 bymating interaction between the two types of fastener material. Thus whenusing the Velcro™ type hook-and-loop fastening materials describedabove, the piece of hook-bearing fastener material 132 on the outer end34 of the strap member 30 mates securely with the loop-bearing fastenermaterial 52 on the exterior side 50 of the intermediate portion 38 ofthe strap member 30. The second end portion 26 of the main body portion14 of the pelvic sling 112 overlaps the first end portion 18 and can bepositioned by the medical service provider applying the device 112 as acervical collar to provide the needed support for the chin of thepatient P. With the device ideally located the stays 124 and 126 extendvertically along the neck of the patient P, providing stiffness in alateral direction with respect to the main body portion 14, that is,generally vertically along the neck of the patient P as shown in FIG.14. Medical personnel can, if necessary, bend one or both of the stays124, 126 to conform as desired to the patient's shoulders, neck, andhead, and the device 112 can be placed on the neck of the patient P inthe location deemed most appropriate to place the stays 124 and 126where required, which may ordinarily be in a generally symmetricalarrangement with the stay 124 near the patient's left ear or jaw and thestay 126 near the patient's right ear or jaw. With the device wrappedaround the neck of the patient P and the outer end 34 of the strapmember 30 secured to the intermediate portion 38 of the strap 30 asshown in FIG. 14, the bladder 114 may be inflated as desired to providesupport and to cause the interior layer 46 of fabric of the main bodyportion 14 to conform to and press against the neck of the patient Pwith a desired amount of pressure, by adjusting the extent of inflationof the bladder 114. Either the pelvic sling 140 or the pelvic sling 150would also be applied to the support the neck of a patient P in the samemanner shown in FIG. 14, with the exception of additionally having theoptional use of the additional bladders 144, 146, 154, and 156 to modifythe amount of support provided to the neck of patient P, and that inapplication of the pelvic sling 150 as a cervical collar the stays 124and 126 are not available to provide support for the neck of the patientP as with the pelvic slings 112, and 140.

Referring next to FIGS. 15 and 16, a pelvic sling 160 is yet anotherembodiment of the pelvic sling shown in FIGS. 1-10 and is generallysimilar to the pelvic sling 12 except as will be described presently.The pelvic sling 160 is shown including a piece 123 of loop-bearingfastener material attached to the second end portion 126 of the mainbody portion 14. As with the pelvic slings 112, 140, and 150, an area ofhook-bearing flexible fastener material 132 is attached to the interiorside of the strap member 30 at its outer end 34.

On one side of the first end portion 18 a margin is shaped to define aconcave-shaped chin receptacle part 162 spanning a distance 164 ofseveral inches of the main body portion 14 of the pelvic sling 160 foruse of the pelvic sling 160 as a cervical collar as shown in FIG. 16.The distance 164 may, for example, be in the range of 4-8 inches andmore preferably in the range of about 5-7 inches when the pelvic sling160 is straightened out into a flat condition as shown in FIG. 15. Whilean arcuate concave chin receptacle 162 is shown the shape may vary, solong as there is some concavity and opposite sides to receive and helpto stabilize the chin of the patient P.

For the sake of simplicity, the pelvic sling 160 is shown in FIGS. 15and 16 with the simple construction of the main body portion 14 similarto that shown in FIGS. 1-10, without showing any bladders or stays. Itwill be understood that in another embodiment including the concavemargin defining the chin receptacle 162, one or more bladders might beincluded as shown in FIGS. 11, 11A, 12, and 13. Similarly, stays 124 and126 might be included in the pelvic sling 160.

When the pelvic sling 160 is used as a cervical collar, as shown in FIG.16, it can be placed under the chin of a patient P as shown in FIG. 16to receive and assist in stabilizing the chin of the patient P as thebody portion 14 is wrapped around the neck of the patient P and theouter end 34 of the strap member 30 is connected to the intermediateportion 38 of the strap member 30 by interaction of the hook-bearingfastener material in the area 132 with the loop-bearing fastenermaterial 52 on the exterior side 50 of the intermediate portion 38 ofthe strap member 30, as shown in FIG. 16.

A pelvic sling 170, shown in FIGS. 17-19, is similar to the pelvic sling160 shown in FIGS. 15 and 16, except with respect to its first endportion 18, where there is a moveable chin support piece 172 attached tothe margin of the outer end portion 18 and aligned with the concave chinreceptacle portion 162 of the margin of the outer end portion 18. Asshown in FIG. 17, the outer end portion 18 is flat, as in FIG. 15, andthe movable chin support piece 172 is in a retracted, or non-deployed,position lying closely alongside the interior face of the main bodyportion 14 of the pelvic sling 170. The moveable chin support piece 172is attached to the margin of the end portion 18 by a pair of hinges 174and 176 located near the opposite ends 178 and 180 of the moveable chinsupport piece 172. The hinges 174 and 176 have respective hinge axes 175and 177 aligned with the locations on the concave chin rest marginportion 162 where each hinge is attached and interconnects the endportion 18 with the moveable chin support piece, and as a result theaxes 175 and 177 of the hinges 174 and 176 are coplanar but notparallel, and diverge from each other by an obtuse angle, as seen inFIG. 17, when the end portion 18 lies flat.

The moveable chin support piece 172 may be of a somewhat stiff andself-supporting yet flexible material such as multiple layers of heavylaminated textile fabric, or a somewhat flexible yet fairly stiffsynthetic plastics material, so that the moveable chin support piece isable to flex along with the end portion 18 and lie closely alongside itwhen the pelvic sling 170 incorporating such a moveable chin supportpiece 172 is applied as a pelvic sling with the moveable chin supportpiece 172 in the retracted, non-deployed position shown in FIG. 17. Thehinges 174 and 176 may be, for example, short pieces of narrow strongtextile fabric such as nylon webbing sewn to the concave portion 162 ofthe margin of the end portion 18 and to the concave inner margin of themoveable chin support piece 172. Alternatively, particularly if themoveable chin support piece 172 is of molded plastics material, thehinges 174 and 176 may be “live” plastic hinges with connected ears thatcan be sewn or otherwise fastened in well-known ways to the material ofthe outer end portion 18 and the chin support piece 172. Also instead ofbeing permanently attached and moveable, the chin support piece 172could be attached to the end portion 18 of the main body portion 14 bydetachable fasteners, such as Velcro, snap fasteners, or buttons.

When it is desired to use the pelvic sling 170 as a cervical collar, themoveable chin support piece 172 can be deployed to the exterior side ofthe end portion 18. With the end portion 18 bent as shown in FIGS. 18and 19 so as to fit around and conform to the neck of a patient P, theaxes of rotation of the hinges 174 and 176 are no longer coplanar, butare oriented differently with respect to each other, so that themoveable chin support piece 172 is held in a nearly horizontalorientation extending outwardly from the outer end portion 18 with anupwardly concave curved shape, so that it can support and cradle thechin of the patient P as shown in FIG. 19. Thus when the pelvic sling170 is used as a cervical collar as shown in FIG. 19 the moveable chinsupport piece 172 is deployed, and the main body portion 14 is placed onthe neck of the patient P so it can support and cradle the chin of thepatient P. The second end portion 26 of the pelvic sling 170, dependingupon the size and circumference of the neck of the patient P, mayprovide more or less additional support beneath the moveable chinsupport piece 172, with the outer end 34 of the strap member 30 securedto the intermediate portion 38 of the strap member 30 by interactionbetween the area 132 of hook-bearing fastener material on the outer end34 of the strap member with the loop-bearing fastener material 52 on theintermediate portion 38 of the strap member 30.

It will be understood that the main body portion 14 of the pelvic sling170 might be constructed in any desired one of the variousconfigurations shown in FIGS. 1-13, to include or not to include one ormore inflatable bladders and transversely-oriented stays while stillincorporating the moveable chin support piece 172.

Depending upon whether it is desired for the pelvic sling 170 to be ableto be used only once or for more or fewer patients P, it will beunderstood that the moveable chin support piece 172 may also be made ofvarious materials such as plastics, impregnated cloth or laminatedpaper, for example.

Referring next to FIGS. 20-32, a pelvic sling and junctional or truncalpoint pressure tourniquet 190 shown in FIG. 20 includes the ability tocompress a blood vessel such as a femoral artery, iliac artery, brachialartery, axillary artery, carotid artery, abdominal aorta or subclavianartery, as well as being able to perform the functions of a pelvic slingas described above.

The pelvic sling and junctional or truncal point tourniquet 190disclosed herein may also be used to provide perfusion support in lowflow disease states such as hemorrhagic shock and cardiac arrest, as byapplying pressure to limit blood flow to distal parts of a patient andthereby reducing the size of the portion of the body where artificiallyassisted circulation is in effect.

The pelvic sling and tourniquet 190 shown in FIG. 20 includes a mainbody portion 192 similar to the main body portion 14 of the device 12shown in FIGS. 1-4, with the general shape of a wide belt. The main bodyportion 192 may be constructed of, for example, a pair of flexible,substantially inelastic sheets of strong loop-bearing flexible fastenermaterial defining a wide central portion 194 with a width 196 of about 7inches, for example, and a pair of tapered opposite end portions 198 and200. Alternatively, the main body 192 may be of another strong cloth,such as a polyethylene fiber fabric, covered by the loop-bearingfastener material, and may include a padding layer of batting (notshown). A buckle 202, which may be similar to the buckle 16 of thedevice 12 shown in FIGS. 1-4, and which is therefore not described indetail here, is attached to the first end portion 198 of the main body192, preferably by a pivoting connection. A loop 204 of strong webbingmaterial may engage the buckle, and corresponding holes in that webbingmaterial and in the first end 198 of the main body 192 may beinterconnected by a fastener such as a short bolt 206. The holes in thefirst end portion 148 and the webbing material 204 attached to thebuckle 202 may be suitably reinforced, as by the use of metal grommets.

At the second end portion 200 of the main body an inner end of anelongate flexible strap 30 similar to the strap member 30 of the pelvicslings 112, 140, 160, and 170 is permanently attached to the main body192, as by being sewn, riveted, or thermally or sonically weldedsecurely to the second end 200 of the main body 192. The strap 30extends longitudinally away from the second end portion, generallyaligned with the longitudinal axis of the main body portion 192. Anouter end portion 34 of the strap 30 may include a loop 208 of strongfabric such as nylon webbing material covered by hook-bearing fastenermaterial 210 on at least the outer face of the part adjacent to theouter face of the strap 30. The strap 30 may be of strong, inelasticflexible nylon webbing, and at least an intermediate portion 212 has alayer of loop-bearing flexible fastener material 213 securely attachedto and extending along an outer face 214 of the strap.

The strap 30 is provided with pairs of holes 216 to interact with thebuckle 202 as explained above in connection with the pelvic sling 12 andbuckle 16, so that the main body portion 192 and the strap member 30form a loop under tension when the buckle 202 is engaged with the strapmember 30, to act as a support for application of pressure inward withrespect to that loop.

In the central portion 194 of the main body 192, between the two layersof loop-bearing fastener material, is an inflatable bladder 220 similarto the bladder 114 of the pelvic sling 112 described above. The bladder220 may be generally rectangular and of flexible sheet plastic, and maybe referred to as a backing bladder. An inflation or fill tube 222 isconnected to the bladder 220, and a valve 224, such as a luer activatedvalve, may be connected with the outer end of the tube 222. The bladder220 may be inflated by the use of a small pump, such as a squeeze bulb226 with an outlet tube 228 equipped with a corresponding connector suchas a luer fitting 229 at its outer end. A valve 230 may be provided atthe squeeze bulb or pump outlet, to provide for relieving pressure andexhausting fluid from within the bladder 220 when desired, and apressure gauge 231 may also be connected with the squeeze bulb 228 orother pump to provide a medical caregiver a means of assessing forcelevel.

A strip 232 of hook-bearing flexible fastener material, an inch inwidth, for example, extends along and is securely fastened to the mainbody portion on its outer face 234, so that the loop-bearing fastenermaterial 213 on the outer face 214 of the strap 30 can mate with and beheld against the outer face 234 of the main body portion when the strap30 extends through the buckle 202 and is bent back alongside the mainbody 192 as shown in FIGS. 23 and 24.

A loop 240 of material such as Nylon webbing fits snugly around thestrap 30. A face of the loop 240 on the inner side of the strap 30 isprovided with an area 242 of loop-bearing fastener material, and aselectively inflatable point pressure application device 244 may beattached to the loop 240 on the inner side of the strap 30 by acorresponding area 246 of mating hook-bearing fastener material attachedto the base of the point pressure device, as will be explained ingreater detail below. The loop 240 may be slid along the strap 30 to adesired position between the end 200 of the main body 192 and the buckle202 to attach the point pressure device 244 to the strap 30.

One or more point pressure devices 244 may also be attached removably tothe inner face 248 of the main body portion 192 at any desired position,by mating interaction of the hook-bearing fastener material 246 on thebase of the point pressure device with the loop-bearing fastenermaterial on the inner face 248 of the main body portion 192. A pointpressure device 244 could also be attached permanently, as by sewing oradhesive attachment, to a selected location on the inner face 248, as inthe end portion 198.

The pelvic sling and truncal and junctional tourniquet 250 shown in FIG.21 is generally similar to the device 190 shown in FIG. 20, except thatthe main body portion 252 of the device is narrower than the main body192, and may have a uniform width 254 of about 3 inches, for example.With such a smaller width, the device 250 may lack an inflatable bladderwithin its main body 252, although its structure may otherwise besimilar to the main body 192, thus including a pair of sheets of strongloop-bearing fastener material, fastened together, and having a strip256 of hook-bearing fastener material attached to and extending along anouter face 258. Optionally, the main body may be of a strong fabric withloop-bearing fastener material attached to both sides. The pelvic slings190 and 250 shown in FIGS. 20 and 21 have been demonstrated toeffectively reduce pelvic fractures when applied at each of threedifferent anatomical levels I, II, and III as shown in FIG. 24.

A selectively inflatable hemostatic point pressure application device244 may also be removably attached to a loop 240 slidably disposed onthe strap portion 30 of the pelvic sling and tourniquet 250, as with thedevice 190, and another such point pressure application device 244 maybe attached removably in a selected location on to the inner face 256 ofthe main body portion 252 by mating interconnection of the fastenermaterials at a desired position along the length of the main bodyportion 252, although the smaller width 254 of the main body portionprovides less choice of position.

Instead of the inflatable bladder contained within the main body portion192 of the pelvic sling and tourniquet 190, the device 250 may beaccompanied by a separate inflatable pressure device 260 having a length262 of for example, about 13 inches, and a width 264 of, for example,about 7 inches, and containing a bladder 266 similar to the bladder 220between a pair of layers of fabric each having an outer surface ofloop-bearing flexible fastener material similar, for example, to that ofthe outside of the main body of the pelvic sling and tourniquet 190. Astrip of hook-bearing fastener material 268 an inch in width, forexample, extends longitudinally along a central axis on each side of theseparate inflatable pressure device 260. A fill tube 270 is provided andmay extend from one end of the inflatable bladder 266 and may beequipped with a connector and fill valve 224 such as the ones describedabove.

As may be seen in FIG. 28, the pelvic sling and truncal tourniquet 250may be rolled tightly, together with a pair of point pressure devices244, into a compact package that can be carried in a minimum amount ofspace, ready for use for emergency treatment of injured personnel, as inmilitary operations where size and weight of emergency medical suppliesmay be critical.

A point pressure device 244, in one embodiment, as is shown in FIGS.29-32, includes a baseplate portion 272, which may be molded of astrong, rigid plastics material, and an inflatable flexible bladderportion 274 having a peripheral rim 276 of a shape and sizecorresponding to the shape of the baseplate 272. The peripheral rim isfastened securely and hermetically sealed, as by an adhesive, orovermolding, or thermal welding, to a top surface of the baseplate 272.An inlet fitting such as a barbed nipple or spigot 278 extendingradially out in the plane of the baseplate 272 defines a bore leadinginward beyond the outer rim portion 276 of the bladder 274 and extendingupward, opening through the top surface of the baseplate 272 to be ableto inflate the bladder. While the baseplate 272 as shown is generallyflat, it could be shaped to correspond to the bladder 274 to be morecompact in a package. The hook-bearing fastener material 246 on thebottom of the point pressure device 244 may be, as shown in FIG. 20, asimple square, or may, as shown in FIG. 30, be shaped to conform moreclosely to the shape of the baseplate 272. A pressure limiting andrelief valve 280 may be mounted in the base 272 as shown in FIGS. 30 and31, to be sure that the bladder 274 doesn't fail because ofoverpressure, and to accommodate changes in ambient air pressure such aswhen a patient is airlifted, so that the bladder 274 does not becomeoverextended or exert more than the desirable amount of pressure againsta patient's body.

A suitable pressure relief valve 280, for example, has a crackingpressure of 21.8 pounds per square inch (150 kPa) ±15 percent. Such apressure relief valve might be press fitted into a boss 282 defined inthe baseplate 272, or press fitted into a brass sleeve ultrasonicallywelded into the boss 282 in the baseplate, or ultrasonically weldeddirectly into the boss in the baseplate, or the baseplate 272 could beover-molded onto the valve 280. Alternatively, a relief valve could beconnected to the point pressure device 244 through tubing connected tothe fill tube spigot 278.

The inflatable flexible bladder portion 274 of the point pressure device244 is of a flexible material such as suitably strong and flexibleplastics material molded in concentric pleats 286 arranged to unfold andallow a central part 288 to extend telescopically from the configurationshown in FIG. 29 to a height 290 as shown in FIG. 32 that is at leastdouble and may be more than four times as great as the collapsed height292 shown in FIG. 29, as a result of inflation and correspondingstraightening of the concentric pleats 286. The central part 288, whenthe bladder 274 is extended, is the outer end of the bladder and isreinforced and thus stiffer than the expanded pleated portions 286 inorder to be able to exert pressure firmly against a patient's body in asmall area, such as a circular area with a diameter of about 2.2 inches,in a desired location, as to compress and hold a wound, or to exertpressure through a patient's tissue in order to compress and occlude amajor blood vessel. In one embodiment of the inflatable point pressuredevice 244 the bladder portion 274 may have a collapsed height of about0.6 inch and a diameter 294 of about 4 inches, with a wall thickness 296of about 0.075 inch and a thickness of the central outer end parts 288of about 0.25 inch. When extended, the height 290 may be about 3.0inches. An inflation or fill tube mounted on the barbed spigot 278 mayhave a valve 224 of a luer activated type similar to that on the bladder220, compatible with the squeeze bulb pump 226 described previously.Alternatively, a valve (not shown) compatible with use of a CO₂cartridge may be provided.

The inflatable point pressure device 244 or the separate inflatablepressure device 260 would be positioned between the belt 30 or the mainbody portion 192 or 252 and the patient, to apply pressure to a wound tobe compressed or vasculature to be occluded. The bladders could beattached and positioned by various means such as being looselysandwiched between the patient and belt, or being attached byhook-and-loop fasteners, clips, straps or the like.

Particularly where medical personnel need to limit blood flow to thelegs, and regardless of whether a pelvic fracture exists or issuspected, to use the pelvic sling 190 or 250 the belt 30 would betightened to a predetermined force dictated by a tension controlmechanism such as the buckle 202 as described in greater detail above.This would provide a baseline force level. The operator would thenactivate one, two, or more separate inflatable pressure devices 260 orinflatable point pressure devices 244 to apply pressure to a wound or topress on the vasculature whose flow is to be limited or stopped.

One alternative to the inflatable bladder point pressure device 244shown would be a screw system (not shown). The pelvic sling would have aseries of threaded holes through the belt 30. Once the belt wastightened to the controlled minimum tension, with a rigid end piecepositioned between the patient and belt a screw would be inserted intoone of the holes and connected to the rigid end piece. As the screw wastightened, force would be directed down towards the patient and thetreatment/occlusion target.

Since patients have different circumferences, the junctional and truncaltourniquets 190 or 250 provides for a means of adjusting the distancebetween inflatable point pressure devices 244. An inflatable pointpressure device 244 on a pelvic sling and junctional and truncaltourniquet 190 or the like could be in a fixed position, possibly closeto the buckle 202. The emergency caregiver could adjust the position ofthe pelvic sling 190 or 250 on the patient so that the point pressuredevice is in the ideal fixed location for treatment or occlusion. Then,the second inflatable point pressure device 244 could be positionedaccording to the patient size and shape. Alternatively, both pointpressure devices 244 could be fixed or both adjustable.

If the point pressure device 244 is to be pre-fixed to the main body 192or 252, this could be done with sewing, hook-and-loop, heat, adhesive,etc.

The separate pressure device 260 or the point pressure device 244 couldbe applied in the pelvic/groin/abdominal region as shown in FIGS. 23,24, 25, and 26 to close and compress open wounds or occlude femoralvessels, iliac vessels or the aorta, or in the shoulder area as shown inFIG. 27 to treat or occlude carotid, axillary or subclavian vessels. Ifused in the shoulder area, the point pressure device may be fitted witha harness, a cup that cups the shoulder or a looping strap that goesaround the shoulder which keeps the device from slipping away from therequired location. With the device worn as shown in FIG. 27 the strapmember 30 may extend from the buckle 202 and over the patient's shoulderto be secured in the desired position and arranged by engaging theloop-bearing fastener material on the strap 30 with the strip ofhook-bearing fastener material 232 on the main body 252.

The bladder 220 and the inflatable pressure devices 244 and 260 may beinflated with the squeeze bulb 226 connected directly or via the tube222 or 228. The pressure devices could instead be inflated via asyringe-like pump, or by an electrically powered air pump, that couldinclude an ambient air pressure sensor and could inflate the bladder andpressure devices to a predetermined pressure. Alternatively, thepressure devices 244 and 260 could be fitted with ports allowingconnection to a pressurized gas chamber such as a disposable 12 gram CO₂cartridge. If the pressure device 260 is fixed to the inside of thejunctional or truncal point tourniquet 190 or 250 it may be desirable tohave the inflation or fill tube extend through the junctional or truncalpoint tourniquet rather than around it, via a port through the belt (notshown) that connects the bladder to the source of inflation. Thecommunication between a bladder and its inflation device could thus bevia tubing or intimate interconnection.

The separate inflatable pressure device 260 could be of square, oval,circular, diamond or other shape to direct force directly inward fromthe main body 192 or 252. The composition of the bladder or fabriccovering the actual bladder, as shown in FIGS. 22 and 23 could be amostly non-elastic material such as loop-bearing fastener material, sothat lateral stretch is reduced and force is directed controllablyinward towards the patient.

The separate inflatable pressure device 260 could also have an attachedrigid cup-like or otherwise protruding element (such as thepressure-concentrating member 408 described below) positioned between itand a patient to assist in focusing force. A rigid body at thebladder-patient interface results in maintaining a static surface areawhile force increases, thereby maximizing focused pressure.

To use the junctional and truncal point tourniquet andpelvis-stabilizing devices 190 and 250 in the pelvic or inguinal area,first insure the bladders 220 and 266 are deflated. If necessary,deflate them by attaching a squeeze bulb 226 and opening the valve 230.Next, position the point pressure devices 244 on the junctional andtruncal point tourniquet as required by the patient's size and thecaregiver's personal preference, such as having the two point pressuredevices 244 on the wider portion of the main body 192 or 252, perhapsaligned with the backing bladder 220. Wrap the junctional and truncalpoint tourniquet device around the patient, aligned on a plane with orproximal to the injury site. The buckle 202 could be in the back or inthe front of the patient depending upon caregiver preference and thecondition of the patient.

Next, thread the holed strap 30 through the buckle 202 and double itback toward the second end 200 of the main body 192, so that theloop-bearing fastener material 213 on the portion of the strap member 30that is doubled back faces toward the main body portion 192 or 252. Ifone of the inflatable point pressure devices 244 is on the sliding loop240, slide the loop to the desired position along the strap member 30.Then, holding the buckle or the main body portion, pull the strap member30 through the buckle 202 with enough force to cause the buckle 202 toclick and engage the holes 216 in the belt member. Then holding thestrap in the same position to keep the buckle 202 engaged in the holesin the strap, press the strap 30 down to the main body 192 or 252 tosecure the loop-bearing fastener material 213 to the strip ofhook-bearing fastener material 232.

Next ensure that the valve 230 in the squeeze bulb 226 is in the closedposition and attach the pump connector fitting 229 to a luer connection224 of one of the inflatable point pressure devices 244, and theninflate the point pressure device 244 as much as possible.

If necessary, to compress a wound or gain tension to improve theeffectiveness of an inflatable point pressure device 244 inflate thebacking bladder 220 in the main body 192 or a separate pressure device260, as well.

For abdominal use of the junctional and truncal point tourniquet andpelvis-stabilizing devices 190 and 250, first ensure the bladders 220and 266 are deflated as explained above. Position an inflatable pointpressure device 244 in the center of the central portion 194 of the mainbody 192, over the backing bladder 220. Wrap the junctional and truncalpoint tourniquet 190 or 250 around the patient with the inflatable pointpressure device 244 centered over the patient's umbilicus. Thereafterproceed as explained above with respect to pelvic or inguinal area useto tension the device around the patient and inflate the point pressuredevice 244, and, if necessary inflate the backing bladder 220 to obtainthe desired result, such as occlusion of the abdominal aorta.

For use of the junctional and truncal point tourniquet andpelvis-stabilizing devices 190 and 250 to occlude the axillary artery orclose a wound in the axilla prepare the device by ensuring the bladders220 and 266 are deflated as explained previously and position one ormore of the inflatable point pressure devices on the main body 192 or252 or on the sliding loop 240 as explained above, and then wrap thejunctional and truncal point tourniquet 190 or 250 around the patient,crossing under both shoulders. Align the inflatable point pressuredevice 244 on or proximal to an injury site and thread the end of thestrap 30 through the buckle 202 and pull the outer end of the strap 30until the buckle clicks and engages the holes 216 in the strap member30. Retaining tension in the strap to keep the buckle 202 engaged, passthe outer portion of the strap 30 over the top of a shoulder of thepatient, depending on the desired configuration, and press the strapagainst the outer face of the main body of the device to mate theloop-bearing fastener material 213 with the strip of hook-bearingmaterial 232 or 256 on the main body 192 or 252 to secure the strapmember 30 and retain the desired tension in the tourniquet 190 or 250.Depending upon the location of a wound or other factors that may beinvolved the device may be placed on the patient in various ways toaccomplish the desired results. Once the tourniquet 190 or 250 is in thedesired position the inflatable point pressure device or devices shouldbe inflated, and if necessary, the backing bladder 220, or a separateinflatable pressure device 260 should be inflated.

In some cases one of the inflatable point pressure devices 244 or aseparate inflatable pressure device 260 may be useful separately, inwhich case the bladder 266 or 274 should initially be deflated asexplained above. The pressure device 244 or 260 should be placed overthe injury site or proximal to it and secured in place with a suitablebandage, ensuring that the fill tube and its connection fitting or valve224 is accessible, after which the inflatable pressure device 244 or 260should be inflated.

Referring now to FIGS. 33-35, a junctional and truncal point tourniquetand pelvis-stabilizing device 281, at times called simply a tourniquet281 below, has a main body 283 of strong flexible relatively inelasticand non-absorbent fabric such as a pair of layers of 500 Denier CorduraNylon, and is generally similar in shape to the main body 192 of thepelvic sling and truncal and junctional tourniquet 190 except that itmay have a smaller width 284 of about 4 inches, for example.

At a first end portion 287 of the main body 283 a receptacle or femalepart 289 of a quick release fastener such as a side release buckle isattached to the main body 283, as by a sewn loop of webbing material.Also attached to the first end portion 287, as by another loop ofwebbing material, is a link 291 which may be a D-ring of molded plasticresin material. A handle 293 in the form of, for example, a loop ofwebbing material may also be attached to the first end 287 of the mainbody 283. At an opposite second end portion 295 of the main body 283, aninner end of a strap member 297 is attached to the main body 283. Thestrap member 297 is similar to the strap member 30 of the previouslydescribed pelvic sling 12, in general, and defines a series of pairs ofholes 40 along its length arranged to interact with a force-controllingbuckle 301, generally similar to the previously described buckles 16 and202, which has pins 72 that can engage the holes 40 once a desiredamount of force is applied. Instead of being attached to the first end287 of the main body 283 by a loop of webbing material as in the sling12, however, the buckle 301 has, attached to its frame, the male portion302 of a side release buckle that is releasably mateable with the bucklereceptacle 289 mounted at the first end 287 of the main body 283. Unlesstension is applied in the strap member 297 the buckle 301 is free toslide along the strap member 297 between a soft stop 304, which may be ashort piece of fabric or plastic, attached to the strap member 297 andextending to each side far enough to impede movement of the buckle 301without application of some amount of force, and a retainer 306 locatednear the outer end 308 of the strap member 297 to keep the buckle 300 onthe strap member 296. A handle 310, in the form of a loop of webbingmaterial such as that of which the strap member 297 is formed, may beprovided at the outer end 308.

At least one face of the strap member 297 may include a layer ofloop-bearing fastener material 311, and a patch of hook-bearing fastenermaterial 54 may be provided on the loop 310.

On the outer face 312 of the main body 283, at a location between thefirst end portion 287 and the second end portion 295 of the main body,an auxiliary strap 314 is attached. As shown in FIG. 33, it may befolded and stowed within a pocket having an opening 316 defined on amargin of the main body 283. The opening 316 permits the auxiliary strap314 to be stowed easily and neatly, as when the device 281 has been usedin training. A first end 318 of the auxiliary strap 314 is securelyattached to the main body, as by being sewn to it within the pocket andextending through a slit, as may be seen best in FIG. 35. Ideally, thedistance 319 between the location where the first end 318 is fastenedand the attachment of the link 291 to the first end portion 287 is 50percent of the 50^(th) percentile of adult chest circumference, or about20.2 inches (51 cm) from the fastening of the link 291 to the first endportion 287 of the main body 283. A buckle 320 forms a loop spaced apartfrom the first end 318, attaching a swivel attached to a fastener whichmay be a snap hook 322 and which is preferably of a size which can beinserted through and mated in the opening in the D-ring fitting 291 onthe first end 286 of the main body 283 as will be explained presently. Akeeper 324 such as a Velcro-retained strip of fabric may be utilized toretain the hook 322 when the strap member 314 is folded and stowedwithin the pocket 316. The keeper 324 may be a narrow strip of materialincluding loop-bearing fastener material, and a small area ofhook-bearing fastener material may be provided on the outer face 312 toreceive and retain the keeper 324 as shown in FIG. 35.

Areas of loop-pile bearing fastener material 328 and an area ofhook-bearing material 330 may be located on the outer face 312 of themain body 283 at its second end 295 to mate with and secure the strapmember 297 when it has been engaged with the buckle 301 when thetourniquet 281 is in use on a person.

As may be seen in FIG. 34, an area 332 of loop pile bearing fastenermaterial may be attached to the inner face 334 of the main body 283 atthe first end 286.

An inflatable point pressure device 340 may include mating hook-bearingfastener material attached to its baseplate 272, and may be is attachedto the inner face 334 of the main body 283 by the loop pile bearingfastener material 332, in a position which may be selected as requiredto place the point pressure device in an effective location for use ofthe tourniquet 281.

In FIG. 36, which is generally similar to FIG. 25, the tourniquet 281 isshown in place on a patient, around the patient's pelvis, where it maybe utilized to stabilize a fractured pelvis and to control hemorrhage inthe lower extremities by occluding the flow of blood through the femoralarteries.

Since the force-controlling buckle 301 is slidable, and located andretained on the strap member 297 as shown in FIG. 33, the tourniquet 281may be applied quickly. Preliminary to placement of the main body 283around the patient's pelvis an inflatable point pressure device 340 islocated on and attached to the fastener material 332 on the inner face334, at the first end 287 of the main body 283 in a position calculatedto facilitate bringing pressure against the femoral artery to stophemorrhaging from the leg. The tourniquet 281 is then applied by placingthe main body 283 around the patient's pelvis and snapping the siderelease buckle male portion 302 into the female portion or receptacle289 on the first end 287. The strap member 297, including the soft stop304, may then be pulled through the buckle 300 by the handle loop 310while the handle 293 on the first end 287 of the main body 283 is pulledin the opposite direction until the force-controlling buckle 301 isoperated by sufficient tension to engage the pins 72 in a pair of theopenings 40 in the strap member 297 at the appropriate position to holdthe strap member 297 and maintain the desired amount of tension in itand the main body 283.

With the tension maintained by engagement of the buckle 301 the outerend of the strap member 297 is attached to the second end 295 by theengagement of the hook-bearing fastener material 330 in the loop pilematerial 311 on the inner face of the strap member 297 to keep thebuckle 301 engaged.

If hemorrhaging is present in both legs a second point pressure device340 may be attached to the strap member 297 before the tourniquet 281 istightened. As may be seen in FIG. 37, with the tourniquet 281 in placeas just described for the purpose of stabilizing a fractured pelvis andtreating hemorrhaging in one or both legs, the auxiliary strap 314remains stowed in its pocket within the main body 283.

The tourniquet 281 may also be used in various other locations on apatient's abdomen in a manner similar to use of the truncal pointtourniquets 190 and 250 as described above, or on the upper torso, asshown particularly in FIGS. 38 and 39, where the tourniquet 281 is shownused to control hemorrhaging by occluding the subclavian artery of apatient. With a point pressure device 340 attached to the first endportion 287 the main body 283 has been placed around the patient's chestjust below the arms, and the tourniquet 281 has been placed in tensionaround the patient's chest, as may be seen by the projection of the pins70 of the buckle 301 through a pair of holes 40 in the strap member 297in FIG. 38, so that tension will hold the point pressure device 340against the chest of the patient. The auxiliary, or shoulder, strap 314has been extended, and the snap hook 322 has been engaged in the openingin the D-ring-like fitting 291. The auxiliary strap 314 has beenshortened sufficiently, using the buckle 320, to pull upwardly on thefirst end 287 of the main body 283, thus ensuring that the pointpressure device 340 is held firmly against the patient in the requiredposition to be able to exert pressure to occlude the subclavian arteryto reduce hemorrhage. Because of the snug fit the tension in theauxiliary strap 314 will retain the point pressure device 314, althoughloop-pile or Omni-tape™ fastener material could be mounted on theauxiliary strap 314 to provide added security.

As mentioned above, placement of the tourniquet 281 and point pressuredevice 340 could be adjusted in order to utilize the point pressuredevice 340 to occlude the carotid or axillary arteries.

FIG. 39 shows the auxiliary strap or shoulder strap 314 extending fromthe mid portion of the main body 283 over the shoulder of the patienttoward the D-ring fitting 291. Also seen in FIG. 39 is the outer end ofthe strap member 296.

In some cases placement of a point pressure device 340 appropriately andproviding tension in the main body 283 may be sufficient to cause thepoint pressure device 340 to occlude an artery such as the subclavianartery and thus stop hemorrhaging. In many cases, however, it will benecessary to apply additional concentrated pressure to occlude a bloodvessel by inflating the point pressure device 340, as will be shown andexplained in greater detail presently.

A junctional and truncal point tourniquet and pelvis-stabilizing device350 shown in FIGS. 40-44 is similar in many respects to the junctionaland truncal point tourniquet and pelvis-stabilizing device 281. A mainbody portion 352 is somewhat larger than the main body 283 of the device281 but has a tension-bearing connecting or strap member 354 similar tothe strap member 297 attached to and extending from a second end portion356. A handle 358 is attached to the first end portion 360 of the mainbody 352. A buckle 301 is disposed on the strap member 354 and slidablealong it between a hard stop 364, which may be in the form of a plasticrod with bent-over ends sewn into a loop along the strap member 354 nearits outer end 308 and handle loop 310, and the second end portion 356 ofthe main body 352. A loop 366 of fabric bulging apart from the strapmember 354 may be provided a short distance toward the main body 352from the hard stop 364 as a soft stop to keep the buckle 301 near thehard stop 364, so that it is readily available when applying the device350 to a patient. A movable loop 362 of loop-pile fastener material maybe located on the strap member 354 to receive a hook-bearing fastener tosupport an inflatable point pressure device 340. Having the buckle 301close to the outer end 308 of the strap member allows the male part 302of a strong quick-release fastener, such as a side release buckleextending from the frame of the buckle 301, to be inserted easily intothe female part or receptacle 289 of the side release buckle, attachedto the main body 352 near its first end portion 360.

Also as in the tourniquet 281, the strap member 354 has fastenermaterial 311 applied securely along one side, and mating fastenermaterial 368 is located on the outer face 370 of the main body 352adjacent the second end portion 356. The specific loop-pile andhook-bearing fastener materials such as at 311, 328, 330, 332, 368, 378,379, 382, and 384 may be replaced by “Omni-Tape™”, a fastener materialcombining hooks and loops and able to connect with other pieces of thesame material.

The main body 352 may be of two layers of suitably strong, flexible andgenerally inelastic fabric bound together about the periphery except ata pocket opening 372, which may be provided with Velcro or other similarfastener material to keep the pocket closed normally.

An auxiliary strap 374 may have a handle in the form of a loop 376normally kept attached to the outer face 370 and in a non-obstructingposition, by fastener material 378 on the outer face 370 and matinghook-bearing fastener material 379 on the loop 376. An end of theauxiliary strap 374 is fastened to the main body 352 within the pocket.The auxiliary strap 374 may be folded and kept within the main bodyportion 352, extending out through a slit 380. The auxiliary strapmaterial 374 may be reached through the pocket opening 372 to fold itinto a compact, neat configuration when the auxiliary strap is not to beused.

As shown in FIG. 42 in particular, each side of the auxiliary strap 374may be covered with fastener material 382 that can be engaged byhook-bearing fastener material 384 located on each side of the slit 380.

As shown best in FIG. 41, a strip 388 of fastener material may beattached to and extend along a medial portion of the inner face 390.Alternatively, the entire inner face 390 may be covered in loop pilefastener material.

Utilization of the junctional and truncal point tourniquet andpelvis-stabilizing device 350 in a pelvis-stabilizing application, or asa junctional tourniquet for occluding a femoral artery is essentiallythe same as utilization of the device 281 as described above and neednot be described in detail.

As shown in FIGS. 43 and 44, however, utilization as a junctional pointtourniquet, as to occlude a subclavian artery, is slightly different.The tourniquet 350 is placed around a patient's torso beneath thearmpits and secured to provide a predetermined amount of tension aroundthe patient's chest by action of the buckle 301 as described previously.Because of the somewhat greater width of the main body portion 352 ofthe device 350, however, an inflatable point pressure application device340 attached to the inner face 390 of the main body 352 by the fasteningmaterial 388 may not be appropriately located to apply occlusivepressure against the subclavian artery. The point pressure device 340may, instead, be attached to the auxiliary strap 374 by fasteningmaterial on its baseplate 272, as shown best in FIG. 43. The auxiliarystrap 374 is extended from the pocket within the middle of the main body352 along the patient's back and over the patient's shoulder, and islooped inside and back up around the outer side of the first end portion360 of the main body 352. The hook-bearing fastener material 379 on theloop 376 is used to engage the fastener material along the length of theauxiliary strap 374 to make the auxiliary strap 374 snug, and tomaintain tension in the auxiliary strap 374 to hold the inflatable pointpressure application device 340 tightly against the patient's body. Theinflatable point pressure application device is then inflated, asnecessary, to provide enough pressure against the patient to occlude thesubclavian artery.

The inflatable point pressure device 340 is shown in FIGS. 45, 46, 47,and 48 in sectional view in order to illustrate its function ofoccluding an artery or other vessel. The point pressure device 340 issimilar in most respects to the point pressure device 244 describedpreviously, and so it is not necessary to repeat that description here.Reference numerals used in the previous description of the pointpressure device 244 will be used in connection with the point pressuredevice 340.

In FIG. 45, the inflatable point pressure device 340 is not inflated butis in its normal relaxed condition. The central part 288 is a relativelyrigid centrally located pressure member having a pressure face. A pairof concentric pleats 286 define, respectively, an inner ridge 402surrounding the central part 288 and an outer ridge 404 surrounding boththe central part 288 and the inner ridge 402, with both the top of thecentral part 288 and the tops of the two ridges 402, 404 lyingessentially within a single plane. As shown in FIG. 45, with a bloodvessel 398 located beneath the surface 400 of the skin of a patient,when the point pressure device 340 is held against the patient's skin,as by the tension in the main body 283 and strap member 297 of thejunctional tourniquet 281 or by tension in the auxiliary strap 314extending over the shoulder of a patient, the inner and outer ridges402, 404 and the central part 288 all exert some pressure against theblood vessel 398, tending to squeeze it and thus reduce its patency andstop the flow through the blood vessel 398 to the location of ahemorrhage.

While each pressure point against the blood vessel should have someeffect, the total effect may in some cases be insufficient, and, ratherthan increase the tension in the main body 283 and connecting strapmember 297, additional pressure to occlude the blood vessel 398 may beprovided by increasing pressure within the inflatable part of the pointpressure device 340, raising the central part 288 and unfolding theouter pleat 286, revising the shape of the point pressure device to 340to the configuration shown in FIG. 46, where only the inner ridge 402and the central part 288 continue to press against the patient, but withincreased pressure over a smaller area, so that the more concentratedpressure can better squeeze the blood vessel 398 to occlude the flow ofblood to the location of the hemorrhage. Thus, as shown in FIG. 46 theinner ridge 402 presses on the blood vessel 398 on each side of thecentral part 288 with greater force and pressure than shown in FIG. 45.

If inflation to the form shown in FIG. 46 is insufficient the inflatableflexible bladder portion 274 can be inflated to a higher pressure,unfolding the pleat 286 defining the inner ridge 402 and leaving onlythe central part 288 pressing against the skin surface 400 and tendingto squeeze and occlude the blood vessel 298. Depending on the totalityof factors including the amount of tension in the tourniquet, thethickness of tissue between the skin surface 400 and the blood vessel398, the size of the blood vessel 398, and the blood pressure within theblood vessel 398, flow of blood through the blood vessel 398 may or maynot be completely occluded. If the situation suggests it to the persontreating the injured person, or if occlusion does not occur, possiblybecause of one of the factors mentioned above, a pressure-concentratingmember 408 may be fitted onto the central part 288 of the point pressuredevice 340, so that when the point pressure device 340 is inflatedpressure on the blood vessel 398 can be concentrated and increasedsufficiently to occlude the blood vessel 398 and stop hemorrhaging fromoccurring or from being fed by the blood vessel 398. Thepressure-concentrating member 408 may be made of a substantially rigidplastics material in a form such as that shown in FIGS. 49, 50, and 51,for example. A base portion 410 is designed to fit snugly onto thecentral part 288, with a skirt 412 fitting around the periphery of thecentral part 288. The base thus defines a shallow cavity 414 in whichthe central part 288 fits snugly to press against the underside of thebase 410. A pressing face 416 smaller than the pressing face of thecentral part 288 may be supported and spaced apart from the base 410 adistance of, for example, 0.8 inches by a suitable supporting structure418, and the entire pressure-concentrating member may be a monolithicmolded plastic device. The pressing face 716 may, for example, be about1 inch long and ⅝ inch wide.

The pressure-concentrating member 408 is ideally shaped to fit in wherethe central part 288 of the point pressure device 340 may be too large.For example, the best subclavian artery pressure point is between theclavicle and the upper rib and is fairly deep. The extra extension andsmall size of the pressing face 416 of the pressure-concentrating member408 can reach the subclavian artery.

As shown in FIG. 51, the pressure-concentrating member ideally is placedupon the central part 288 so that when pressed against the blood vessel398 it extends transversely across the blood vessel 398 so as to providemaximum pressure to flatten and squeeze the blood vessel 398 closed tostop hemorrhaging flow through the blood vessel 398.

Preferably the truncal and junctional tourniquet and pelvis-stabilizingdevice 280 may be packaged in a tightly folded configuration andcontained within a protective covering such as shrink wrapped orvacuumed packed envelope 422 as shown in FIG. 52. This preferred compactpackage is desired to make it possible for military personnel oremergency medical personnel in ambulances, for example, to carry such adevice so that it is readily available for use yet does not take up somuch space that it prevents the caregiver from carrying other essentialemergency care equipment in the available space.

The terms and expressions which have been employed in the foregoingspecification are used therein as terms of description and not oflimitation, and there is no intention in the use of such terms andexpressions of excluding equivalents of the features shown and describedor portions thereof, it being recognized that the scope of the inventionis defined and limited only by the claims which follow.

What is claimed is:
 1. A device for controlling hemorrhage, comprising:(a) an elongate main body portion having opposite first and second endportions, an inner face, and an outer face; (b) a force-control bucklearranged to interconnect the opposite first and second end portions ofthe main body portion; (c) a selectively inflatable hemostatic pressureapplication device attached to said inner face of said main body portionso as to direct hemostatic pressure inward toward a body of a patient;and (d) an auxiliary strap having a length and a first end attached tosaid main body portion, a part of said auxiliary strap spaced apart fromsaid first end being selectively and releasably connected to said mainbody portion adjacent one of said opposite first and second end portionsthereof.
 2. The device of claim 1 including a flexible tension-bearingconnecting member having an inner end part permanently attached to saidsecond end portion of said main body portion, the connecting memberextending away from the main body portion and having an outer end partopposite from said inner end part thereof, and wherein the force-controlbuckle defines an opening through which said tension-bearing connectingmember extends slidably and the force-control buckle operates to engageand retain the tension-bearing connecting member only with apredetermined tension applied to the force-control buckle by thetension-bearing connecting member, so as to interconnect the first andsecond end portions of the main body portion with each other and thus toform a loop with said predetermined tension and to maintain saidpredetermined tension in the main body portion to surround and hold abody of a person.
 3. The device of claim 2 wherein said force-controlbuckle has a frame disposed about said strap and has a quick-releasefastener mounted on said frame, and wherein a quick-release fastenerreceptacle capable of mating with said quick-release fastener on saidframe and sustaining said predetermined tension is attached to saidfirst end of said support member.
 4. The device of claim 2 wherein saidforce-control buckle includes a quick-release fastener portion andwherein a receptacle is attached to said first end portion of said mainbody portion and arranged to receive and mate with said quick-releasefastener portion of said force-control buckle.
 5. The device of claim 4wherein said force-control buckle is retained on said flexibletension-bearing connecting member ready for use upon mating saidquick-release fastener portion with said receptacle.
 6. The device ofclaim 1 including a device on said auxiliary strap, spaced apart fromthe first end of the auxiliary strap and arranged to adjust theeffective length of the auxiliary strap.
 7. The device of claim 6including a selectively operable fastener carried on said auxiliarystrap and wherein one of said end portions of said main body portion hasa receptacle for said selectively operable fastener by which saidauxiliary strap can be connected to said end portion of said main bodyportion.
 8. The device of claim 1 wherein said auxiliary strap isattached to said outer face of said main body portion and wherein saidmain body portion defines a pocket holding a portion of said auxiliarystrap when said auxiliary strap is disconnected from said one of saidopposite end portions of said main body portion.
 9. The device of claim1 wherein said first end of said auxiliary strap is attached to saidmain body portion at a position between said opposite first and secondend portions of said main body portion where said first end will be at apatient's back when said main body is positioned around the patient'schest.
 10. The device of claim 1 wherein said main body portion is ofstrong, flexible, substantially inelastic textile fabric and said deviceis capable of being folded or rolled and vacuum packed in a compactconfiguration.
 11. The device of claim 1 including apressure-concentrating member attached to said selectively inflatablehemostatic pressure application device, the pressure-concentratingmember including a base attached to said selectively inflatablehemostatic pressure application device, and a rigid pressing facesupported by said base and spaced apart from said selectively inflatablehemostatic pressure application device surface.
 12. A device forstabilizing a fractured pelvis or controlling hemorrhage, or both,comprising: (a) an elongate main body portion having opposite first andsecond end portions, an inner face, and an outer face; (b) aforce-control buckle arranged to interconnect the opposite first andsecond end portions of the main body portion; (c) a flexibletension-bearing connecting member having an inner part fixedly attachedto said second end portion of said main body portion, the connectingmember extending away from the main body portion and having an outer endportion opposite from said inner end portion thereof, the force-controlbuckle operating to engage and retain the tension-bearing connectingmember only with at least a predetermined tension applied to the firstconnector by the tension-bearing connecting member, so as tointerconnect the first and second end portions of the main body portionwith each other and thus form a loop and to maintain tension in the mainbody portion to surround and hold a body of a person; (d) an auxiliarystrap having a length and a first end attached to said main body, a partof said auxiliary strap spaced apart from said first end of saidauxiliary strap being selectively and releasably connected to said mainbody adjacent one of said opposite first and second end portionsthereof; (e) an inflatable controllably-expansible point pressureapplication device attached removably at a selected location on aselected one of said main body portion, said tension-bearing connectingmember, and said auxiliary strap, so as to direct pressure inwardly withrespect to said loop at said selected location.
 13. The device of claim12 wherein said force-control buckle has a frame disposed about saidstrap and has a quick-release fastener mounted on said frame, andwherein a quick-release fastener receptacle capable of mating with saidquick-release fastener on said frame and sustaining said predeterminedtension is attached to said first end of said support member.
 14. Thedevice of claim 13 wherein said quick-release fastener includes aside-release buckle arrangement.
 15. An inflatable hemostatic pointpressure device, comprising: (a) a baseplate; (b) a flexible extensibleportion having an outer marginal portion attached sealingly to saidbaseplate, the baseplate and the flexible extensible portion togetherdefining an inflatable body having an interior; and (c) an inflationconduit communicating with said interior of said inflatable body; andwherein the extensible portion includes: (d) a relatively rigidcentrally located pressure member having a pressing face spaced apartfrom the baseplate and oriented generally parallel with the baseplate,and a relatively flexible resiliently elastic portion surrounding saidcentral pressure member and folded to define a pair of annular channelsand a pair of annular first and second ridges, each of said first andsecond ridges having an upper surface substantially in a plane parallelwith said baseplate and including said pressing face of said centralpressure member, so long as pressure within said inflatable body isinsufficient to force said central pressure member away from saidbaseplate.
 16. The point pressure device of claim 15, including apressure-concentrating member attached to said centrally locatedpressure member, the pressure-concentrating member including a baseattached to said pressing face and having a rigid pressing face smallerthan said pressing face of said centrally located pressure membersupported by said base and spaced apart from said pressing face of saidcentrally located pressure member.
 17. An inflatable hemostatic pointpressure device, comprising: (a) a baseplate; (b) a flexible extensibleportion having an outer marginal portion attached sealingly to saidbaseplate, the baseplate and the flexible extensible portion togetherdefining an inflatable body having an interior; and (c) an inflationconduit communicating with said interior of said inflatable body; andwherein the extensible portion includes: (d) a relatively rigidcentrally located pressure member having a pressing face spaced apartfrom the baseplate and oriented generally parallel with the baseplate,and a relatively flexible resiliently elastic portion surrounding saidcentral pressure member, and a pressure-concentrating member attached tosaid centrally located pressure member, the pressure-concentratingmember having a base attached to said pressing face of said centrallylocated pressure member and a rigid pressing face smaller than saidpressing face of said centrally located pressure member and spaced apartfrom said base.
 18. A method of controlling hemorrhage, comprising: (a)applying a device having an elongate belt-like main body includingopposite first and second end portions and with an inflatable pointpressure device carried on said device adjacent one of said oppositefirst and second end portions, around a person in a position where saidpoint pressure device can be aligned with a source of hemorrhaging; (b)arranging said device in a loop surrounding the person and tighteningthe device to a predetermined hoop tension in said main body; (c)thereafter, inflating said point pressure device and thereby applyingsufficient pressure to said person to control flow in a major bloodvessel supplying blood to said hemorrhage.
 19. The method of claim 18wherein said step of tightening said device to a predetermined hooptension includes providing a strap permanently attached to and extendingfrom one of said opposite end portions of said main body and providing aforce-control buckle and disposing said force-control buckle moveably onsaid strap; releasably fastening said force-control buckle to areceptacle permanently attached to the other end portion of said mainbody; pulling an outer end of said strap, thereby moving said strapthrough said buckle and generating tension in said main body; engagingsaid force-control buckle with said strap at a predetermined level oftension; and fastening a portion of said strap to said main body toretain engagement of said strap with said force-control buckle.
 20. Themethod of claim 18 including applying said device around a patient'storso; extending an auxiliary strap from said main body over saidpatient's shoulder and connecting said auxiliary strap to a selected oneof said main body and said strap; and adjusting tension in saidauxiliary strap to hold said main body and said inflatable pointpressure device in a required position on said patient's torso.
 21. Themethod of claim 18 including providing a pressure-concentrating member,attaching said pressure-concentrating member to a central pressuremember of said point pressure device, and inflating said point pressuredevice, and thereby urging said pressure-concentrating member againstsaid patient with sufficient force to occlude a selected blood vessel.22. The method of claim 20 including providing a pair of concentricridges around a central pressure member of said inflatablepoint-pressure device and urging a plurality of said ridges into contactwith said patient's body by utilization of said tension in said mainbody.